Date Presented 4/20/2018
We used a mixed methods approach to explore the experiences of college students with chronic health conditions. Students demonstrated poor performance of self-management occupations, which limited their health and functional outcomes. Occupational therapy’s role in primary care for college students is discussed.
Primary Author and Speaker: Jaclyn Schwartz
Contributing Authors: Erin Reimer, Emily Slayton, Lori Karlin
PURPOSE: Occupational therapy practitioners and researchers are increasingly exploring their role in primary care. Much of the research has focused on traditional ambulatory care and federally qualified health centers (Murphy et al., 2017). Occupational therapy research has also explored working with college students with disabilities (Kreider et al., 2017). However, little research has described the need for occupational therapy primary care services for college students with chronic health conditions. The purpose of this study was to explore the experiences of college students with chronic health conditions to guide future occupational therapy research and practice in this area.
METHOD: This study was an exploratory mixed methods study. Through word of mouth and paper and electronic flyers, we recruited adult college students with chronic health conditions. We administered the Adherence to Refills and Medications Survey, the Newest Vital Sign health literacy assessment, the Communications With Physician Scale, and the Chronic Disease Self-Efficacy Scales. Participants’ results on these standardized assessments were compared to clinically meaningful cut points.
We also conducted semistructured interviews to attain an occupational profile and to understand barriers and facilitators to managing a chronic health condition as a college student. Interviews were transcribed and coded line by line. Coding began with open coding and progressed to axial coding. Constant comparative analysis was used to distill participants’ comments related to the process of self-management, barriers, and facilitators into themes. Triangulation was achieved through comparison among interviews, survey data, and literature reviews.
RESULTS: Thirteen college students with chronic health conditions participated in the study. Participants indicated poor self-efficacy (17%), medication adherence (91%), health literacy (17%), and communication with physicians (27%). Those with poor self-management skills reported a negative impact on their grades and ability to stay in school. Qualitatively, participants reported that barriers to performance included lack of social support, symptoms of their condition and medication side-effects, and lack of adaptive routines.
CONCLUSION: Approximately 30% of these college students struggled to complete their health self-management and maintenance occupations. The Person–Environment–Occupation–Performance model suggests that with intervention, students can improve performance of these occupations, resulting in improved function and well–being. The Developmental Model suggests that adaptive health self-management routines in college may translate to better health self-management as an adult. These findings in the context of theory suggest that occupational therapy practitioners can work on college campuses to help students with chronic health conditions learn how to better manage their health. Future research with a larger, more heterogeneous sample is warranted.
References
Kreider, C., Wu, C.-Y., Percival, S., Lan, M.-F., & Byrd, C. (2017, June). Comprehensive support model for university students with learning disorders. Paper presented at the Occupational Therapy Summit of Scholars, Boston.
Leland, N. E., Fogelberg, D. J., Halle, A. D., & Mroz, T. M. (2016). Occupational therapy and management of multiple chronic conditions in the context of health care reform. American Journal of Occupational Therapy, 71, 7101090010. https://doi.org/10.5014/ajot.2017.711001
Murphy, A. D., Griffith, V. M., Mroz, T. M., & Jirikowic, T. L. (2017). Primary care for underserved populations: Navigating policy to incorporate occupational therapy into federally qualified health centers. American Journal of Occupational Therapy, 71, 7102090010. https://doi.org/10.5014/ajot.2017.712001
Plotnikoff, R. C., Costigan, S. A., Williams, R. L., Hutchesson, M. J., Kennedy, S. G., Robards, S. L., . . . Germov, J. (2015). Effectiveness of interventions targeting physical activity, nutrition and healthy weight for university and college students: A systematic review and meta-analysis. International Journal of Behavioral Nutrition and Physical Activity, 12(1), 45. https://doi.org/10.1186/s12966-015-0203-7
